Nurses start push for ballot measure on staffing

The Massachusetts Nurses Association has begun what could become a big and expensive campaign to convince voters that hospitals are unsafely understaffed and need to hire more nurses.

The union, which includes nearly 3,000 nurses in Worcester, is promoting a question that would appear on the 2014 ballot and ask voters to mandate nurse staffing levels at hospitals. The ballot initiative comes after the full Legislature failed to pass a staffing law, despite more than a decade of prodding from the nurses union. Hospitals oppose the measure.

"We feel this is the only way that it's going to get through," said Lynne P. Starbard, a maternity nurse at UMass Memorial Medical Center's Memorial Campus. "We've tried the Legislature many times, but it would go through the House and stand still at the Senate."

Worcester nurses will begin collecting signatures for the ballot measure Wednesday in Boston, Springfield and at the Worcester Senior Center.

Patient loads and staffing levels have been longstanding concerns for hospital nurses in Massachusetts and for a national union, National Nurses United. Staffing was at the center of a contract dispute between UMass Memorial Health Care Inc. and its nurses earlier this year. Nurses voted to go on strike to protest what they called unsafe staffing, but ultimately avoided the strike with a last-minute deal in which hospital administrators agreed to hire more nurses.

Still, the union, which represents 20 percent of the state's nurses, argues a statewide law is needed.

"We had to take a strike vote for our safe staffing," Ms. Starbard said. "The next contract, they can come around and take it away from us again."

Hospitals are under increasing pressure to control costs, which often includes cutting staff. At UMass Memorial's three campuses in Worcester, registered nurses represent nearly one-third of the 6,857 workers.

"Nurses and other health care professionals see an eternal battle going on between themselves and the bean counters," said Gary N. Chaison, professor of industrial relations at Clark University.

The union proposal would cap the number of patients assigned to a nurse at four. Ratios would be even stricter — one nurse to two patients — in certain areas such as intensive care units. Nurses now see up to seven patients at a time, according to the union.

The only state to pass a nurse staffing law is California, and while unions point to it as a success, a study found that increased staffing had no direct effect on the quality of care. The study also said hospitals had trouble absorbing the costs of the ratios, and many had to reduce services as a result.

The Massachusetts ballot initiative would require hospitals across the state to hire thousands of additional nurses, according to the union. The cost to hospitals would be significant and would force cuts of other hospital staff, according to the Massachusetts Hospital Association.

"When you change the system so the center is no longer the patient, but certain members of the care-giving team, there are implications to other members of the care-giving team," said Tim Gens, executive vice president of the association, noting that doctors, pharmacists, physical therapists, technicians and others also spend time with patients.

UMass Memorial Medical Center is working to add nurses to comply with the contracts it signed with its unions this year. But President Patrick Muldoon called statewide staffing ratios too rigid and said UMass Memorial routinely adjusts staffing to meet patient demand.

"It should be the local hospitals, the leadership of the hospitals, the people closest to the bedside, making those decisions," he said.

While hospital executives, including Mr. Muldoon, say they're committed to providing safe care, the nurses union argues hospitals are putting patients at risk with current staffing levels. Length of stay, readmissions and falls could be prevented — and the associated costs saved — if hospitals hire more nurses, they say.

"People see it when they're admitted, they see it when their families are admitted here," said Colleen E. Wolfe, an interventional radiology nurse at Memorial Campus. "They wait too long, they're sharing their nurse with too many other patients. Unfortunately, they do suffer preventable mistakes."

The union is working to collect 70,000 signatures to put its proposal on the November 2014 statewide ballot. Its allies in the Legislature also have filed bills in the House and Senate. Union spokesman David Schildmeier said he hopes the ballot question spurs lawmakers to act on the issue, and if they don't, the union will try to convince voters to approve it.

"We are willing to spend what it takes to get it passed," he said.

State Rep. Mary S. Keefe, D-Worcester, is supporting the union proposal and said voters are also likely to side with the nurses. "There's a good shot it will pass," she said. "I think it's something that people can really relate to."

Mr. Chaison, the labor relations expert at Clark, also expects the ballot question to pick up support. "I think they have an excellent chance," he said. "People like nurses."